{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" F AIRAMONARDEM","gend":1,"add":"neerG 903rD robrA ","city":"Fredericksburg           ","state":"VA","zip":"22407-6313","dob":"1950-11-15","age":"","mstatus":"","insh":"10119695","cliId":"","pno":"4432399978","cno":5712411951,"email":"","ename":"","eno":"","pphy":"GALDAMEZ, GLORIA E","ppno":5404236600,"pcpadd":"4604 SPOTSYLVANIA PKWY STE 200,","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":224087763,"pcpcounty":"","pcpid":"","pcpname":"SPOTSYLVANIA MULTI-SPECIALTY GROUP","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"309 Green Arbor Dr","madd2":"","madd3":"","mcity":"Fredericksburg           ","mstate":"VA","mzip":"22407-6313","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","M06.9","E11.9","E78.2","E55.9","D53.9","R51.9","M25.50","N12","R10.11","R10.13","R00.2","R05","M19.042","M19.041","M17.0","M47.816","M16.0","R93.89","K59.04","R10.84","K62.5","Z86.010","M15.9","M81.0","M54.42","M05.60","Z68.36","Z74.09","Z74.1","Z88.0","E11.42","K21.9","E11.59","Z79.899","Z79.01","Z87.39","R07.9","R06.02","E78.5","R30.0","S22.070A","Z87.440","Z90.710","H04.123","N30.00","N26.1","R74.01","R10.9","M54.30","N28.1","R39.81","Z99.3","R12","J30.81","J30.1","J30.89","M54.89","R11.0","M19.90","G89.29","R07.81","M79.18","M13.80","M54.50","M41.80","M43.16","I25.10","I77.1","E66.9","I25.2","Z79.02","Z79.1","Z79.83","Z68.38","M54.9","M54.16","M54.17","M48.062","H43.811","Z12.31","R79.1","Z20.822","J40","L60.3","L60.0","M79.675","M79.674","J20.9","M54.14","K59.09","J30.9","Z13.820","M85.852","M54.6","R32","L60.9","M54.5","M17.11","M17.12","M25.551","M16.12","M25.572","M79.672","R06.00","R06.2","J30.2","Z00.00","Z78.0","Z12.11","R10.12","S20.211A","F32.A","M54.2","I49.3","R11.2","T40.2X1A","M51.36","E87.5","M47.27","M25.552","M25.562","N10","M79.641","M79.642","M25.561","T40.601A","M85.89","L85.3","F33.9","E11.69","E66.01"],"date":["2022-12-31","2022-11-22","2022-11-18","2022-11-18","2022-11-18","2022-11-18","2022-11-18","2022-11-18","2022-01-07","2021-11-29","2021-11-29","2022-09-12","2021-08-27","2020-11-16","2020-11-16","2020-11-16","2022-01-20","2020-11-16","2022-01-17","2022-05-23","2022-02-23","2021-02-03","2021-02-03","2020-12-09","2022-09-15","2020-12-09","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-08-18","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2021-09-30","2022-09-12","2022-11-11","2022-08-09","2022-01-07","2021-11-28","2021-11-28","2020-11-06","2021-07-31","2021-07-31","2021-07-31","2022-11-30","2022-01-20","2022-01-17","2022-09-21","2022-09-21","2021-03-04","2022-09-20","2022-09-20","2022-09-20","2022-03-30","2021-07-31","2021-09-14","2022-09-15","2022-07-14","2022-07-14","2022-09-01","2021-12-10","2021-10-21","2021-12-10","2022-03-04","2021-09-30","2022-11-22","2022-03-04","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-12-10","2022-07-14","2022-04-22","2022-07-14","2021-11-10","2022-02-14","2021-03-24","2022-10-25","2022-10-25","2023-01-05","2022-08-18","2022-08-18","2022-08-18","2021-08-04","2022-07-14","2022-11-30","2022-03-30","2020-10-30","2020-10-30","2021-08-17","2021-08-17","2021-08-17","2021-01-18","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2021-01-18","2022-03-08","2022-11-22","2021-08-30","2022-11-22","2022-02-10","2022-02-10","2022-02-10","2022-08-26","2022-12-08","2022-03-30","2022-03-30","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2022-01-19","2021-02-01","2021-01-18","2021-01-18","2021-11-28","2020-11-11","2020-11-11","2020-11-11","2021-07-31","2020-10-30","2022-03-08","2022-03-04","2022-03-04","2022-03-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","65862019399","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","90","Select","Select",""],["","99073070827","FREESTYLE","TES LITE","100","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","270","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","65162070684","AZELASTINE","SPR 0.0015","30","Select","Select",""],["","65162089129","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","68180055809","QUINAPRIL","TAB 20MG","30","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","90","Select","Select",""],["","60758056130","TAZAROTENE","CRE 0.001","30","Select","Select",""],["","00469260230","MYRBETRIQ","TAB 50MG","90","Select","Select",""],["","70069000701","OLOPATADINE","DRO 0.001","5","Select","Select",""],["","68180038909","FENOFIBRATE","TAB 145MG","90","Select","Select",""],["","00006505506","LAGEVRIO","CAP 200MG","40","Select","Select",""],["","49281012065","FLUZONE HD","INJ PF 20-21","0.7","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","180","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8.5","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","51672127304","FLUOCINONIDE","SOL 0.0005","60","Select","Select",""],["","45802041954","AMMONIUM LAC","LOT 0.12","225","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","90","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","20.1","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","30","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","14","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","20","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}